Approaches to Red Eye

Question 1

General approach to red eye

Answer 1

-Unilateral vs bilateral redness
-Always look at the lids before the eye(s)!
-Presence of fluorescein staining esp. if the cornea is clear
-Corneal appearance; clear or hazy; focally or diffusely hazy
-Difference in the pupil size (anisocoria)
-Presence of photophobia
-Direct ophthalmoscope gives an illuminated magnified view

Question 2

Causes of bilateral red eye

Answer 2

LESS SERIOUS
-Infection (conjunctivitis): predominantly gritty & burning with a PURULENT discharge
-Allergy (conjunctivitis): predominantly ITCHY with a MUCOUS discharge
-Dry eyes: usually ‘white/slightly pink eyes’ but predominantly gritty &burning with NO discharge

Question 3

What to look for in the eyelids

Answer 3

-Lid margin lesions
-Entropion/trichiasis
-Lagophthalmos

Question 4

What is the purpose of fluorescein dye?

Answer 4

Always instil fluorescein dye into a red or sore eye to confirm/exclude an epithelial keratitis

-Observe corneal scarring
=If clear epithelial keratitis
=If focally hazy, stromal keratitis (bacterial)

Question 5

When is anisocoria present?

Answer 5

-Acute angle closure glaucoma is always accompanied by the presence of a larger pupil (which is unreactive) in the ipsilateral redeye

Question 6

What red eye conditions are associated with photophobia?

Answer 6

-Keratitis
-Iritis

Question 7

Is the eye painful and tender to touch?

Answer 7

-Scleritis; eye painful and tender
-Episcleritis; discomfort and nontender

-Usually sectorial (vs diffuse redness) n.b. first confirm no ‘corneal explanation’ for sectorial redness

Question 8

Major causes of red eye

Answer 8

-Acute angle closure glaucoma
-Iritis
-Keratitis
-Scleritis

Question 9

Minor causes of red eye

Answer 9

-Conjunctivitis
-Dry eye
-Blepharitis
-Episcleritis

Question 10

Causes of media opacities

Answer 10

-Cataract
-Vitreous haemorrhage